Category: Home Health Reimbursement
PDGM Series: The 2020 Proposed Rule Update
By Melinda A. Gaboury, CEO / Posted on: August 27, 2019January 1, 2020 will bring many new beginnings, including the Patient Driven Groupings Model (PDGM). No doubt the largest reimbursement system overhaul in home health since October 2000.
CMS continues to tweak the model and updates to the Claims Processing Manuals have begun.
VIEW POSTOASIS-D1 Update & PDGM Impact
By Melinda A. Gaboury, CEO / Posted on: July 1, 2019CMS has announced that the revised OASIS-D1 instruments will be effective January 1, 2020. Changes to the OASIS-D data set and data collection guidance were finalized in the Calendar Year (CY) 2019 HH Final Rule, CMS 1689-FC.
VIEW POSTAre You Prepared? The Patient Driven Groupings Model (PDGM) Is Coming Soon
By Melinda A. Gaboury, CEO / Posted on: April 30, 2019Home health agencies may find many of the changes to OASIS-D daunting, but there are several modifications that have helped make assessments easier than ever before. The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) is the primary driving force behind the OASIS changes.
VIEW POSTReview Choice Demonstration Implementation Plan
By Melinda A. Gaboury, CEO / Posted on: April 3, 2019The choice selection period for HHAs located in Illinois will begin on April 17, 2019 and end on May 16, 2019. Agencies in the other four targeted states; Ohio, North Carolina, Texas and Florida, should begin immediate preparation for RCD as it is imminent in your state!
VIEW POST7 Best Practices and Tips for OASIS-D Compliance and Home Health Quality Assurance
By Melinda A. Gaboury, CEO / Posted on: April 2, 2019Home health agencies may find many of the changes to OASIS-D daunting, but there are several modifications that have helped make assessments easier than ever before. The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) is the primary driving force behind the OASIS changes.
VIEW POSTThe Review Choice Demonstration (RCD) Is Here!
By Melinda A. Gaboury, CEO / Posted on: March 13, 2019The Office of Management & Budget (OMB) officially approved implementation of the Review Choice Demonstration in Home Health. Review Choice Demonstration (RCD) for Home Health Services will give providers in the demonstration states an initial choice of three options…
VIEW POSTAgencies at Risk for Missing FIPS Codes
By Melinda A. Gaboury, CEO / Posted on: January 30, 2019Home Health Agencies across the country are at risk for penalties and recouped claims if the FIPS code is NOT reported on ALL CLAIMS!
VIEW POST2019 Rural Add-On Changes
By Melinda A. Gaboury, CEO / Posted on: November 30, 2018As if the changes in the payment system were not enough. Based on the 2019 Medicare Home Health Final Rule, released in early November 2018, the Rural Add-On is being completely revised.
VIEW POST2019 Value Based Purchasing Proposed Changes (UPDATED)
By Melinda A. Gaboury, CEO / Posted on: August 27, 2018The Centers for Medicare and Medicaid Service (CMS) finalized all of the proposed changes to the Value-Based Purchasing (VBP) Model for implementation January 1, 2019. One of the refinements of VBP removed five measures, while adding two new composite measures.
VIEW POST2019 Home Health Proposed Payment Rule – PDGM 2020
By Melinda A. Gaboury, CEO / Posted on: August 8, 2018The Centers for Medicare and Medicaid Service (CMS) released the CY2019 Medicare Home Health payment rule July 12, 2018. This proposed rule is voluminous and carries an immense number of proposed changes. HPS will continue analyzing and updating the proposed elements of this rule.
VIEW POSTPre-Claim Review Demonstration Coming Back?
By Melinda A. Gaboury, CEO / Posted on: June 7, 2018CMS released a Comment Request, via the Federal Register, regarding Pre-Claim Review Demonstration being set to return on or after October 2018 in Illinois, Ohio, North Carolina, Florida, and Texas. The revised demonstration would last five years and Illinois will kick off the demonstration again and will be followed by Ohio and North Carolina and later Texas and Florida.
VIEW POSTTargeted Probe and Educate – What We Have Learned So Far
By Melinda A. Gaboury, CEO / Posted on: March 13, 2018Targeted Probe & Educate began on 10/1/17 and is full speed ahead. HPS has discovered nuances with TPE that we did not expect nor have we experienced in past ADR reviews. This review includes targeted medical review and education along with the potential of elevated action toward the agency. This elevated action could take place if the agency is not meeting the standards laid out by the Medicare MAC.
VIEW POSTHome Health & Hospice PEPPER Reports
By Melinda A. Gaboury, CEO / Posted on: January 15, 2018Over the past couple of years, HPS has reported and discussed that Home Health and Hospice PEPPER Reports are very important and should be reviewed by all agencies. We have also been open about the number of agencies in the country that have never opened the reports. HPS is happy to report that, for the 8 months ending December 20, 2017, 58.5% of all hospices have opened their reports. Only 5 states and 1 territory are below 50%. The sad news is that home care…
VIEW POSTNew Medicare Beneficiary Identifiers
By Melinda A. Gaboury, CEO / Posted on: December 20, 2017HPS has given you a couple of updates on the new Medicare Beneficiary Identifier (MBI) cards over the past few months and we continue that update today. Following are more questions answered about the new Medicare numbers and how that will affect your agency. Key dates to remember: April 1, 2018 – Patients will begin to receive new Medicare cards and agencies should begin the process of asking…
VIEW POST2018 Home Health Final Rule
By Melinda A. Gaboury, CEO / Posted on: November 14, 2017The Breaking News that has every one full of excitement and hope is that the 2018 Home Health Final Rule does NOT include finalizing HHGM, at this time, which was set for implementation in 2019! The battle has been won, BUT the war has just begun! Some form of payment reform will occur in home health. It is not…
VIEW POSTClaim Denials Due to NO OASIS Will Now Return to Provider
By Melinda A. Gaboury, CEO / Posted on: October 23, 2017The claim edit that has been in place since April 3, 2017 has been denying home health claims, at the point of billing, if the matching OASIS was not in the ASAP database. Some of these denials have been the result of data not matching between the claim and the OASIS, primarily the patient’s HIC number being different or the OASIS…
VIEW POSTNew Medicare Cards – Questions Answered
By Melinda A. Gaboury, CEO / Posted on: October 10, 2017HPS reported on the coming changes to the Medicare cards a few months ago. Today we offer more answers as have been gathered from CMS via the Medicare Learning Network page of the CMS site. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, requires the removal…
VIEW POSTTargeted Probe and Educate
By Melinda A. Gaboury, CEO / Posted on: September 25, 2017HPS reported recently regarding continued Probe & Educate for Home Health agencies. This is to clarify that the CMS expansion on Probe & Educate is for Home Health and Hospice and will be effective 10/1/2017. This is referred to as Targeted Probe & Educate (TPE). This review will include targeted medical review and education along with an option for potential elevated action, up to and including referral to other Medicare contractors including the Zone Program Integrity Contractor (ZPIC), Unified Program Integrity Contractor (UPIC), Recovery Audit Contractor (RAC), etc.
VIEW POST2018 Home Health Proposed Payment Rule – Including Intro to HHGM
By Melinda A. Gaboury, CEO / Posted on: July 31, 2017The Centers for Medicare and Medicaid Service (CMS) released the CY2018 Medicare Home Health payment rule last week. This proposed rule is voluminous and carries an immense number of proposed changes. HPS will continue analyzing and updating on the proposed elements of this rule.
VIEW POSTDelayed Implementation of Home Health CoPs
By Melinda A. Gaboury, CEO / Posted on: July 14, 2017Last week CMS issued a Final Rule that changed the new Home Health CoPs rule implementation date to January 13, 2018. HPS announced the proposed rule a few months ago. NAHC and the Forum of State Associations spearheaded this effort to postpone the rule because of the extensive changes that are…
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Changes Coming to Medicare HIC Numbers – Medicare Beneficiary Identifier
By Aaron Carey / Posted on: June 22, 2017Former President Harry S. Truman was the very first Medicare beneficiary to be issued a Health Insurance Claim Number (HICN) when then President Lyndon B Johnson signed the Medicare program into law on July 30, 1965. Ever since then, Medicare beneficiaries upon entitlement, have been issued a Health Insurance Claim Number (HICN). The primary issuer of the HICN is the social security administration with the railroad retirement Board issuing HIC numbers for railroad workers. Beginning in 2018 the Medicare HIC number will be replaced with a new identifier called a Medicare Beneficiary Identifier (MBI). The MBI numbers will be…
VIEW POSTHome Health PEPPER is HOT!
By Melinda A. Gaboury, CEO / Posted on: May 26, 2017One of the Hot Topics surrounding the medical review contractors and Medicare MACs is Home Health PEPPER (Program for Evaluating Payment Patterns Electronic Report)! Pepper is an accumulation and calculation of certain statistics that result from claims data. These Medicare claims data statistics are calculated for areas that may be at risk for improper Medicare payments such as…
VIEW POSTHow To Access The Provider Statistical & Reimbursement Report
By Aaron Carey / Posted on: March 17, 2017It is that time of year again. Cost report season for home health and hospice providers. Cost reports are due five months after your agency fiscal year end. For agencies with a 12/31/16 fiscal year end cost reports are due by 05/31/17.
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HIPAA for Home Care | Establishing A Compliant Agency
By Drew Rowley / Posted on: March 3, 2017HIPAA has become an acronym synonymous with healthcare. We see it practiced and preached daily throughout the home care and hospice industry. However, too often breach notifications are at the top of our industry headlines. These breaches are costing our agencies time, money, and patient credibility. If we as agency owners, administrators, and employees understand the severity of a breach then why are breaches still occurring?
VIEW POSTAre You Thriving?
By Melinda A. Gaboury, CEO / Posted on: January 20, 2017The constant additions of new programs and new methods, updates and consideration of changes is almost unbearable for some agencies. Home Health has been hit really hard since 2008 and no relief seems to be coming. Value-Based Purchasing, Pre-Claim Review, New CoPs, OASIS-C2, ICD-10 CM and now possibly major changes to the Prospective Payment System in regard to reimbursement.
VIEW POSTAre you G Code Savvy?
By Melinda A. Gaboury, CEO / Posted on: January 13, 2017Many have not yet realized that there were additional G codes introduced that went into effect January 1, 2017. These codes were not a part of the 2017 Home Health Final Rule, but were introduced in the CR9736 issued November 10, 2016.
VIEW POSTLate NOE Exceptions Clarified
By Melinda A. Gaboury, CEO / Posted on: January 4, 2017Notices of Election (NOE) that are filed and/or accepted at the Medicare Administrative Contractor (MAC) outside of the required 5 calendar day requirement, penalizes the hospice and the hospice does not receive reimbursement for any services until the NOE is accepted at the MAC. There have been some significant reimbursement issues with hospices due to this requirement, even when the issue was out of the control of the hospice and due to a Medicare system processing issue.
VIEW POSTSearch Home Health in the NEAR Future!
By Melinda A. Gaboury, CEO / Posted on: December 21, 2016…
VIEW POSTReimbursement Impact of OASIS-C2
By Melinda A. Gaboury, CEO / Posted on: October 7, 2016…
VIEW POSTBREAKING NEWS – PRE-CLAIM REVIEW DELAYED
By Melinda A. Gaboury, CEO / Posted on: September 20, 2016…
VIEW POSTWill it Ever End? – Medicare Prior Authorization!
By Melinda A. Gaboury, CEO / Posted on: February 26, 2016…
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Medicaid and F2F: The Day has Officially Arrived!
By Dedra Briggs / Posted on: February 9, 2016…
VIEW POSTValue Based Purchasing: What We Weren’t Sure of!
By Melinda A. Gaboury, CEO / Posted on: January 14, 2016…
VIEW POST2016 HHRG Tables & Hospice CBSAs!
By Melinda A. Gaboury, CEO / Posted on: December 22, 2015…
VIEW POST2016 HHRG Tables & Hospice CBSAs!
By Melinda A. Gaboury, CEO / Posted on: December 22, 2015…
VIEW POSTUshering In 2016 – Kick off the Year Right!
By Melinda A. Gaboury, CEO / Posted on: December 11, 2015…
VIEW POST2016 Home Health Rates Continued Decline!
By Melinda A. Gaboury, CEO / Posted on: November 13, 2015…
VIEW POSTThe Nervous Nine Have Been Confirmed!
By Melinda A. Gaboury, CEO / Posted on: November 2, 2015…
VIEW POSTNew G-Codes Not JUST for HOSPICE!
By Melinda A. Gaboury, CEO / Posted on: October 23, 2015…
VIEW POSTThe Complexities of Medicare Secondary Payer Billing
By Aaron Carey / Posted on: October 16, 2015…
VIEW POSTHome Care and Hospice: Still No Relief!
By Melinda A. Gaboury, CEO / Posted on: September 11, 2015…
VIEW POSTIs Canceling RAPs a Strategy for your Agency?
By Melinda A. Gaboury, CEO / Posted on: August 31, 2015…
VIEW POSTCMS Issues 2016 FINAL Hospice Rule – Part 2
By Melinda A. Gaboury, CEO / Posted on: August 21, 2015…
VIEW POST2016 Proposed Rates Cannot Be Ignored!
By Melinda A. Gaboury, CEO / Posted on: July 15, 2015…
VIEW POSTMedicare Web Portals – Navigating the “Dark Days”
By Aaron Carey / Posted on: June 28, 2015…
VIEW POSTHome Care HIPPS Code Corrections When Re-Coded
By Melinda A. Gaboury, CEO / Posted on: May 27, 2015…
VIEW POSTMedicare Managed Care – Can it be Managed? (Part Three)
By Aaron Carey / Posted on: April 21, 2015…
VIEW POSTMedicare Managed Care – Can it be Managed? (Part Two)
By Aaron Carey / Posted on: April 15, 2015…
VIEW POSTHome Care Final Rule 2015: Case-Mix & CBSA Changes!
By Melinda A. Gaboury, CEO / Posted on: January 12, 2015…
VIEW POSTHome Care Final Rule 2015: Case-Mix & CBSA Changes!
By Melinda A. Gaboury, CEO / Posted on: January 12, 2015…
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